A system under pressure
We highlight the immense pressure that mental health crisis services are under and how members have told us that there are occasions when no acute mental health assessment beds are available across the country. MHN think that is a national scandal that symbolises the inequalities between mental health and physical health care.
In the briefing we draw on research findings that suggest that:
- There are rising numbers of service user suicides under the care of community crisis teams
- Only half of community teams offer an adequate 24/7 crisis service.
- People with a mental health problem are three times more likely to attend A&E
- People have reported contact with at least three different services when experiencing a mental health crisis.
- People with a mental health problem are almost five times more likely to be an emergency inpatient admission than someone without mental ill health.
It is also widely recognised that the peak hours for mental health presentations at A&E are 11pm - 7am. MHN argues that these factors and more point to a mental health crisis care system in crisis.
Making system wide changes
Building on our previous publication Mental health and policing, this briefing also demonstrates what some providers are doing to tackle some of the key issues in mental health crisis care. Good practice examples from MHN members show how local health and care partners are working as a whole system to tackle some of these key issues in mental health crisis care, including reducing the use of A&E and police services.
Mental health is a ‘must do’
We make the case for mental health to be part of the current re-organisation of services and sustainability and transformation plans and suggest that failing to embed mental health care more deeply within the wider health care system will be a missed trick. Not only will it fail vulnerable individuals, their families and carers but it will seriously challenge the government’s ambitions for mental health to achieve parity of esteem with physical health.
In particular we state that there needs to be full consideration of how STPs will fundamentally improve and sustain the crisis care pathway to ensure that people get the care that they need in their local area. Otherwise the political rhetoric around mental health crisis care will continue to get lost in translation between Whitehall and the frontline of care.
- Our members inform us that there are occasions when there are no routine acute mental health assessment beds available across the country.
- There are concerns that committed government funding for mental health is failing to reach the frontline of care.
- There are further concerns that the sustainability element of STP funding has largely been apportioned to the acute sector.
- People with a mental health problem are 3 times more likely to attend A&E.
- Suicide by patients under community crisis teams is increasing.
- Mental health crisis care needs to be a priority area for transformation.
Bev Humphrey, Chair of the Mental Health Network, said:
“Mental health crisis care is at a tipping point and there are sometimes no routine acute or assessment beds available anywhere in the country. The provision of mental health liaison services in A&E departments and seven-day working in community services remains patchy and underdeveloped. What would be unacceptable for physical illness should not be acceptable for people with mental health problems.
“This is a national scandal and the impact on individuals and their families can be huge. These are distressing and damaging situations where people’s mental health can go from bad to worse. Clinical decision-making is being compromised due to resource shortages and frontline care teams are too often being left to hold the risk. Too little resource for crisis care is a false economy that stores-up significant work for other parts of health and social care. While there are some excellent examples of good practice across the country, services are inconsistent and not being resourced to operate on clinically evidenced standards.
“A combination of slow funding, increased demand and systemic complexity are heaping immense pressure on mental health crisis care. There is a gap between the rhetoric of Government and the ongoing lack of material support reaching frontline services.
“What we need now is for uncertainty to be dispelled. We need to know when promised funding will reach crisis services. We need NHS England to clarify how they will support the Crisis Care Concord after October, which is when the charity Mind’s work on its implementation phase comes to an end. Within the next few months we need national bodies to ensure that crisis care becomes more prominent in local Sustainability and Transformation Plans and to explain whether anything will be left for mental health, as there are concerns that most of the £2.1bn allocation for STPs has been allocated on other areas. Above all we need a more strategic approach, ownership of the problems, transparency on resources and accountability across the system for improving.”